one health: a new paradigm to address infectious diseases · food safety and security global...
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09/12/2012
Tennessee Public Health Association_2012 1
One Health: A New Paradigm to Address Infectious Diseases
TPHA Franklin, TN
September 12, 2012
Lonnie King, DVM, MS, MPA, DACVPMDean College of Veterinary Medicine
Executive Dean Health Science Colleges
Ruth Stanton Chair in Veterinary Medicine
The Ohio State University
OBJECTIVES OF PRESENTATION
Discuss the definition and scope of One health
Elucidate the factors and forces creating the new EID Era and the need for One Health
Demonstrate how the changes in human, animal and environmental domains will challenge PH’s future
Help you envision how One Health will allow you to better improve health in your work and jobs
Give you a foundation to better appreciate other presentations and the focus on this conference on One Health, One Environment and One World
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Historical Epidemiological Transitions
Paleolithic Age
Hunters and gatherers
Nomadic
Small populations
Parasitic infections
Historical Epidemiologic Transitions –1st Transition
10,000 years ago
New social order due to agriculture
Zoonoses through animal domestication
Increases in infectious diseases
Epidemics in non-immune populations
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Deadly Gifts
Human Diseases Animal Origin
Measles Rinderpest of cattle
TB M. bovis of cattle
Smallpox Cowpox
Influenza Pigs and Ducks
Pertussis Pigs and Dogs
Malaria Birds
Guns, Germs and Steel J. Diamond
Historical Epidemiologic Transitions –3rd Transition
Last 30 years
Emerging infectious diseases globally
New diseases and increases in mortality;first since 19th century
Re-emergence
Antimicrobial resistance
75 percent are zoonotic
Anthropogenic factors of emergence;the microbial “perfect storm”
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Physical and Environmental
Factors
Ecological Factors
Humans
Wildlife
Animals
E I D
Social, Political, and Economic
Factors
Genetic and Biological Factors
Convergence Model
Why Diseases EmergeGenetic and biological factors
Microbial adaptation and changeHuman susceptibility to Infection
Physical environmental factorsClimate and weatherEconomic development and land use
Ecological factorsChanging ecosystemsHuman demographics and behavior
Social, political, and economic factorsInternational Travel and commercePoverty and Social inequityWar and FamineLack of political willIntent to harm
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CDC’s Most Significant Global Epidemics Over the Last 15 Years
1993 – Hanta virus
1994 – Plague (India)
Ebola virus (Zaire)
1996 – New Variant of CJD (UK)
H5N1 influenza (Hong Kong)
1998 – Nipah virus (Malaysia)
1999 – West Nile
2000 – Rift Valley fever
2001 – Anthrax
2002 – Norwalk-like viruses
2003 – SARS
2004 – Marburg Virus
2005 – H5N1 Influenza
2006 – E. coli
2007 – P.I.N.
2008 – Salmonella StPaul
2009 – H1N1 Influenza
2010 – Cryptococcus
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Microbial View
Multihost Pathogens
60% of all humanpathogens are zoonotic
80% of animal pathogens
Ecological generalists
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Wicked Issues/Dilemmas
Characteristics of a Wicked Problem or Dilemma:
Complex and tangled
Unprecedented
Difficult to define and enigmatic
Solution is not binary; many choices
Often generate unexpected consequences
Unique and past experiences not helpful
Threatening
Often a symptom of another issue/problem
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ONE HEALTH
One Health is the collaborative effort of multiple disciplines – working locally, nationally and globally - to attain optimal health of humans, animals and
our environment.
What is One Health?
Definition
Holistic, integrative and collaborative
New scientific niche for health
Emphasis on: multiple disciplines and professions; prevention and expansion of professionalknowledge and experiences
Appreciation of the connectivityof domains of health
Targeted research portfolio
One Health
Environment
Human disease
Animal Disease
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The Scope of One Health
Agriculture systems
AMR
Biomedical research
Comparative medicine
Conservation medicine
Diagnostics
Entomology
Food safety and security
Global Trade/commerce
Ecosystems
Climate change
Land use
Mental health
Occupational health
Public policy
Biodiversity
Wildlife health/manage
The Convergence: A New Public Health Kaleidoscope Emphasizing One Health
Animal Health
EnvironmentalHealth
Human Health
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The Convergence: A New Public Health Kaleidoscope Emphasizing One Health
Animal HealthEnvironmental
Health
Human Health
Less developed countries
More developed countries
1950 20000
1
2
3
4
5
6
7
8Billions
1005959085807570656055 15
Year
Global Population: 1950-2015
Source: US Bureau of the Census
Trends in Global Population
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Greatest migration of people in history
• 1900 – 13% urban;
• 2007 – 50%+ urban
Peri-urban areas – newest sitesof confluence
Urbanization is now largely a phenomenon of poor/middle class countries
Creation of new niches for microbes,vectors, and animals
Shift to MegaCities and Urban Sites
www.basgweb.org
The Black Death
(www.scienceclarified.com )
Peri-Urban Slum
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International Tourist Arrivals, 1950-2020
Source: World Tourism Organization (WTO)
World Flights
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Grand Princess and U.S. Capitol
Transportation Revolution Is the Connectivity Revolution for Microbes
1.5 million people move into cities worldwide weekly
Over 50,000 airports
20 million miles of roads
700,000 mile of railroad tracks
Typical manufacturing company relies on more that 35 different contract manufacturers worldwide
300,000 facilities in 150 countries send over 24 million shipments through 300 U.S ports of entry; these represent FDA inspections (only 10% imports)
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Movement Ecology
Migration and
Immigration
Travel and Trade
Microbiome
Global Food Supply
Transboundary Diseases
Diasporas of the Future
Human Demographics
Recreational practices
Shift to foods from animal-proteins
Under-nutrition vs. Over-nutrition
Healthcare vs. health promotion and prevention
Health disparities and exposure bias
Migration and Translocation is unparalleled
Peri-Urban centers
Immuno-compromised population
Aging population- “baby boomers”
Rapid growth in developing world
Exposures to wildlife and vectors
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The Convergence: A New Public Health Kaleidoscope Emphasizing One Health
Animal HealthEnvironmental
Health
Human Health
Last year, almost 24 billion food animals were produced to help feed a population of approximately 7 billion people resulting in trillions of pounds of products distributed
worldwide.
Projections toward 2020 indicate that the demand for animal protein will increase by
50%, especially in developing countries.
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World Meat Consumption,1983 - 2020
Source: Newcomb, J., One World – One Health: An Economic Perspective, 2004
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Trade and Travel
Food and Ag part of $12 trillion global trade
Travelers are interactivebiological units
Create sequential sharedenvironments
Risk of exposure increases 4X when size of conveyances/passengers double
Movements of world’s biota iscreating new interfaces
Trade agreements outpace health agreements
Source: FAO, WHO, Rimsa, Mexico City April 2005
Poultry population density
Human population density
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Hu
man
an
d a
nim
al d
ensi
ty
140
120
100
80
60
40
20
0
Mea
n n
orm
aliz
ed c
rop
pro
du
ctio
n60
50
40
30
20
10
0
Distance to Bangkok (km)
50 100 150 200 250 300 350 400 450 500
Source: Gerber and others 2005.
human population (nb/km2/10)
chicken (nb/km2/10) cassava (tons/km2/2)
maize (tons/km2)soybean (10 tons/km2)
pigs (nb/km2/10)
Human and livestock densities, and main feed production areas as affected by the distance to Bangkok
Ecosystem
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World’s Most Dangerous Animals
Enzootic (Maintenance/Amplification)
Amplifying hosts
Incidental hosts
West Nile Virus:Basic Transmission Cycle
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Reported Human West Nile Virus Cases, by Date of Symptom Onset; and Date of First Positive Surveillance Event, Colorado, 2003
0
10
20
30
40
50
60
70
80
90
100
110
6-Ju
n
20-J
un4-
Jul
18-J
ul
1-Aug
15-A
ug
29-A
ug
12-S
ep
26-S
ep
10-O
ct
24-O
ct
Symptom onset date
No.
of
case
s
Fever(n=2323)Neuroinvasive(n=621)mosquito
human
chicken
bird
horse
Source: John Pape, CO DOH
West Nile Virus in the U.S.cumulative data as of Aug 28, 2012
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West Nile Virus
326 species of birds
Mostly subclinical
Flavivirus
1.5 million cases in U.S.
Culex Mosquitoes
Robins as reservoir
Zoonotic
Ecologically complex
Emerging Fungal Pathogens
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Emerging Fungal Pathogens
Threats to crops, forests and animals
1.5 to 5 million species (70,000 known)
Trade, travel and tourism with environmental persistence
Batrachochytrium dendrobatidis – fungus responsible for the greatest disease-driven loss of biodiversity on record (40% amphibian populations in Central Am.)
Geomyces destructans – White-nose Syndrome of Bats – caused deaths of 6 million bats – E. U.S.A.
Cryptococcus - meningitis – 1 million cases
The edge or transition zone between two adjacent ecological systems
Ecotone
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Winding through rice paddies, tea plantation, and villages in Malaysia, Thailand, Laos, and China, the road mirrors an ancient trade route linking Southeast Asia to the southern branches of the Silk Road.
Route 3 makes it possible to drive from Singapore to Beijing.
Challenges of trans-boundary transmission of communicable
diseases, environmental degradation, and illegal
migration are being addressed.Along Route 3 in Laos
Photo: Justin Mott for The New York Times
Man-made Ecotone
The road rarely follows a straight line as it meanders through rice fields and tea plantations.
Built environmentHuman-Animal InterfaceEcologies and a new researchportfolio
Evidence-based public health
Vector-borne diseases
Water-borne diseases
Agriculture Production
Migration of Animals
Changing ecosystems for wildlife and animals
Climate Change’s Impact onInfectious Diseases
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Lyme Disease
Brownstein et al., 2005
Social
ClimateEcological
Today 2080
Density of Poor Livestock Keepers - 2010
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Poverty, Hunger, Livestock Keeping and Zoonoses (ILRI)
70 % rural poor and 30% urban poor depend on livestock
Assessing 56 zoonoses globally, they are responsible for 2.5 billion cases of human illness and 2.7 million deaths annually
Massive under-reporting yet huge burden of illness especially in the 1 billion people worldwide earning less than $2 a day
Of top zoonoses, most have high impact on L/S, wildlife interfaces and ag amenable
Divided Constituencies: Medical Needs and Veterinary Responsibilities
The crux of the problem is that for many zoonoses, it is the risk to human health that is most important, while the most effective control route is via the animal
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Emerging Retrovirus Zoonoses
2 new retroviruses –Cameroon – Africa
Human T-lymphotropic virus (HTLV) types 3 and 4
Recovered from hunters of nonhuman primates
Role of bushmeat and butchering primates
STLV and HIV withsimilar origins
Risk
Number of catastrophes between 1970 & 2003Source: Swiss Re, Sigma No. 1, 2004
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Why is One Health Important?
Interconnectivity of the world; Triple Threat to Health
Complex, difficult and “wicked” problems
The great convergence and 21st century mixing bowl
Microbial swarms
A world in rapid motion with collapsed space
Food safety, security and water issues
Climate change and consequences
Infectious disease ecology
Shift to new points of intervention; “upstream” shift from clinical care to prevention (ratio 97%:3%)
What Can We Do?
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IOM Consensus of Recommendations
Improve infrastructures – animal/human
Integrate surveillance and diagnostics
Increase R&D investments
Build a new infectious disease workforce
Consider a global perspective
Create zoonosis and EID centers
Improve public understanding
Meet critical needs for leadership/skills
Prevention Intervention
Outbreak prediction
Outbreak investigationand response
CaseReporting
Surveillance
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The scale and complexity of animal and human medical problems embedded in a
changing environment, demand that scientists move beyond the confines of their own disciplines and explore new
organizational models for team science.
Rather than focusing primarily on humans and their interaction with disease-causing organisms, shift focus on interplay among humans, animals, and the environment.
Shift to a holistic view of health, interactions, and exposure.
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Working Successfully at the H-A-E Interface: Key Challenges
Trans-disciplinary efforts
AH-PH Continuum; Integrate Plans and Actions
Shift Attention “Upstream”
New Appreciation for ID Ecology
Addressing Diasporas and Ecotones Earlier
Developing Community Health Teams
Acquiring New Skills and Knowledge
Shift From Reaction to Prevention
Adopting a One Health Mindset
Paradigm Shift
Thomas Kuhn – The Structure of Scientific Revolutions
Characterized by a time when old models don’t work as well and new models have yet to be created.
A time when assumptions must be questioned
Changes may not be led by the scientific community
One Health the final need is a changing value proposition; evidence of reduced morbidity, mortality and costs
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Hicks, Edward. Peaceable Kingdom c. 1834